Mr. Tony O'Brien:

Deputy Fitzpatrick's questions were specific to the Louth-Meath hospital group. At the end of last year we put in place some change management arrangements for that group of hospitals and in the intervening period, we have seen some significant improvements in the access position of the hospital, particularly with trolleys. Our Lady of Lourdes Hospital was a facility that would keep a person awake at night because of some of the 8 a.m. trolley counts but we have seen significant improvement there. The Louth-Meath hospital group will form part of a wider group in the development plan, and one of the purposes of those groups is to give devolved decision-making around the appropriate distribution of services between hospitals rather than issues always being decided at the centre. I know the hospital or group management team for this are examining the appropriate distribution of services across the available sites. Although that will progress, I do not have any information that I can share today, unfortunately, other than recognising there has been some early benefit and a significant degree of ambition by the local management team to continue that. I am confident that will happen.

There was a question on the ambulance service investment, which is a very important area of development. This is particularly pertinent with regard to intermediate care vehicles, which enable a much more responsive and dynamic flow. There is also the centralisation of control, which has significant benefits. There was a question on the ongoing occasional problem of ambulances being delayed because of issues in accident and emergency departments. It has not yet gone away but one of the reasons for the investment in intermediate care vehicles is that sometimes there are problems of egress and access in the same hospital. Beaumont Hospital was mentioned as an example. At times, it would have ambulances held seeking to get in patients while at the same time being unable to obtain transportation services to get patients out who would be going to a referring hospital or to another place of care. The intermediate care vehicle strategy is a central part of that process and it will, in turn, speed up the general turnover within a hospital and make accident and emergency departments more effective. Investment in ambulances and intermediate care vehicles is vital to the overall efficiency, and it is a particular issue in some of the big Dublin hospitals.